Organization
SURGERY CENTER PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY S. HOCHSTETLER M.D. (OWNER)
(231) 929-2500
Entity
Organization
Contact information
Practice address
5080 N ROYAL DR, TRAVERSE CITY, MI 49684-9230
(231) 929-2500
(231) 929-0963
Mailing address
5080 N ROYAL DR, TRAVERSE CITY, MI 49684-9230
(231) 929-2500
(231) 929-0963
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
TH048021
MI
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050B810950
BCBS MD ANES GROUP
MI
01
—
40364
BCBS - TSC
MI
01
—
430B810310
BCBS CRNA GROUP
MI
01
—
490003947
MEDICARE RR
MI
01
—
490B870000
BCBS
MI
01
—
900003210
PRIORITY - TSC
MI
Enumeration date
09/07/2005
Last updated
12/15/2021
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